Legislature(1993 - 1994)

04/14/1994 03:00 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
  HB 545 - DISCRIMINATION UNDER HEALTH INSURANCE                               
  Number 025                                                                   
  DIXIE HOOD, Licensed Marriage and Family Therapist,                          
  testified in support of HB 545.  She said it was not                         
  possible for a board member of the Alaska Association for                    
  Marriage and Family Therapy to attend the meeting, but a                     
  document from Mercy Dennis, chair of the association's                       
  legislative committee, was made available to committee                       
  members.  She presented the following statement:                             
  "My name is Dixie Hood.  I am a licensed marriage and family                 
  therapist in private practice in Juneau.  I am here to ask                   
  your support for HB 545.  This bill would provide licensed                   
  marriage and family therapists parity with other licensed                    
  health care professionals in Alaska.  In addition to private                 
  practice I have worked as a mental health clinician and as a                 
  substance abuse counselor with the Juneau Department of                      
  Health and Social Services.  My training and experience                      
  includes working with clients who are experiencing                           
  depression, severe anxiety, eating disorders, phobias,                       
  schizophrenia and other serious mental disorders as well as                  
  clients who are suffering emotional stress from family or                    
  work situations.  I developed a substance abuse treatment                    
  program at the State Correctional Center at Lemon Creek.  I                  
  mention these things because some of you may have the idea                   
  that the work of marriage and family therapists is limited                   
  to minor personal problems or marriage and divorce                           
  "I would like to briefly describe my own experience in this                  
  profession in Alaska.  Because of limited academic resources                 
  in this state, I went to California for clinical training.                   
  After two years of graduate school, 3,000 supervised hours,                  
  and written and oral exams, I earned licensure in                            
  California.  In California one could not call themselves a                   
  counselor or do the work of counseling without such                          
  preparations and licensure.  I returned to Alaska to work                    
  and learned that there were no standards or license for                      
  counselors and that only a state business license was                        
  required.  For this I paid seven dollars and 50 cents.  This                 
  was ten years ago.  I inquired about the standard counseling                 
  fees in Juneau.  Counselor friends told me that the going                    
  rate was 40 dollars per hour because that was half of what                   
  psychologists charged.  Medical insurance would reimburse 50                 
  percent for services provided by psychologists so 40 dollars                 
  was the amount a client had to pay out of pocket.                            
  Therefore, in order to compete, counselors charged 40                        
  dollars.  It was not a level playing field.  As I                            
  established myself as a psychotherapist in the community I                   
  was able to increase my professional fee to a more                           
  supportable income.  However, Juneau is a government town                    
  with many employees having good medical insurance.  When                     
  seeking health services, they want maximum reimbursement.                    
  Licensed medical doctors, psychiatrists, and psychologists                   
  have been regularly reimbursed by insurance companies.  When                 
  licensed social workers were added to the list of providers                  
  not to be discriminated against, that offered another level                  
  of service and fee options to perspective clients.  Adding                   
  marriage and family therapists to this list would not expand                 
  the number of clients served or the cost.  It would add an                   
  alternative level of treatment.  This is comparable to nurse                 
  practitioners versus physicians for medical treatment.  It                   
  can actually decrease the costs of service.  Marriage and                    
  family therapists are qualified to do much of the same work                  
  as other licensed mental health professionals and can do it                  
  cheaper.  In Juneau there is a shortage of psychiatrists.                    
  They often see clients only for the prescription and                         
  monitoring of medication and not for psychotherapy.  There                   
  are often waiting lists for psychiatrists and psychologists                  
  because of insurance reimbursement considerations.  In many                  
  smaller communities in Alaska there are neither                              
  psychiatrists nor psychologists nor social workers.                          
  "Passage of HB 545 would enable clients some reasonable                      
  options in choosing treatment.  Thanks to lobbying efforts                   
  by the Alaska Association for Marriage and Family Therapy                    
  and the support of the legislature and the administration                    
  two years ago, there are now established standards for                       
  licensing marriage and family therapists in this state.                      
  Parity in terms of third party payment is the logical next                   
  step.  The ability to conduct a private practice depends, to                 
  a significant extent, upon insurance and other forms of                      
  reimbursement.  I urge you to move this bill forward.  I                     
  would be glad to answer any questions."                                      
  Number 080                                                                   
  REP. MULDER asked about the standards adopted for licensure                  
  in Alaska.                                                                   
  Number 082                                                                   
  SHERRIE GOLL, Lobbyist, Alaska Association for Marriage and                  
  Family Therapy, replied that standards are similar to those                  
  in California and consist of a master's degree and 3,000                     
  hours of supervision.                                                        
  MS. HOOD referred to a grandfather clause that enabled those                 
  who qualified to become licensed in Alaska last August.  She                 
  said because she was licensed in California and was also a                   
  member of the American Association for Marriage and Family                   
  Therapy, she presented the necessary background to become                    
  REP. MULDER asked if there were people grandfathered-in who                  
  did not possess the minimum qualifications.                                  
  MS. GOLL indicated that national standards had to be                         
  REP. MULDER asked if a master's level training was offered                   
  in Alaska.                                                                   
  MS. HOOD said she thought the nearest program was in                         
  Seattle.  It was pointed out that neither a social work                      
  program nor a master's level training program was available                  
  in Alaska.                                                                   
  Number 097                                                                   
  REP. GREEN mentioned that nurse practitioners have certain                   
  restrictions as compared to physicians.  Comparably, he                      
  posed a question about the limitations imposed on therapists                 
  when dealing with emotional or psychological problems.                       
  Number 101                                                                   
  MS. HOOD replied that she was trained and qualified to do                    
  psychological evaluations, diagnosis, and treatment within                   
  the range of her background experience.  She stated she was                  
  not able to issue prescription medication or provide                         
  psychological testing.  She added that some marriage and                     
  family therapists have the expertise to do that sort of                      
  testing and therefore the limitation would be in terms of                    
  experience.  She said she has worked at in-patient                           
  psychiatric facilities and also at a day care center for                     
  chronic schizophrenics, so she has worked with a severely                    
  mentally ill population.                                                     
  Number 117                                                                   
  REP. GREEN asked if she would know if she was working with                   
  someone who was depressed as opposed to someone who was                      
  schizophrenic and needed psychiatric treatment.                              
  Number 120                                                                   
  MS. HOOD replied that her responsibility was to do an                        
  evaluation and determine if a situation was within the scope                 
  of her experience and training; if this was not the case,                    
  she would make an appropriate referral.                                      
  Number 125                                                                   
  REP. MULDER said, "You mentioned it would be less expensive                  
  to have you included under this umbrella because you provide                 
  many of the same services for less cost.  How do your                        
  average charges reflect against those of a licensed                          
  Number 129                                                                   
  MS. HOOD replied that her fee is 75 dollars and she believes                 
  the psychiatrists in Juneau charge 100-125 dollars, and                      
  psychologists charge 80-100 dollars.                                         
  Number 134                                                                   
  REP. MULDER asked if it was reasonable to expect that her                    
  fee structure would change if insurance was involved.                        
  MS. HOOD said she did not think this would be the case.  She                 
  explained that the Human Affairs Managed Care Organization                   
  determines an appropriate rate and will not offer                            
  reimbursement if someone charges more than what has been                     
  determined as fair.  She said she knows of at least one                      
  psychologist in Juneau who experienced a problem being                       
  accepted as a preferred provider because insurance was                       
  reluctant to pay the additional amount that was being                        
  Number 149                                                                   
  REP. MULDER asked if any insurance plans currently cover the                 
  services Ms. Hood provides.                                                  
  MS. HOOD replied in the affirmative.                                         
  REP. MULDER asked about the tolerances currently provided by                 
  insurance companies.  He posed a question about the upper                    
  level Ms. Hood could charge and still remain covered by                      
  MS. HOOD said she had not heard a stated figure.                             
  Number 150                                                                   
  REP. MULDER said he thought it was common practice that                      
  insurance companies allowed up to "x" amount of dollars.                     
  MS. GOLL (indiscernible) said the top limit is not really                    
  known because marriage and family therapists charge below                    
  that limit, and therefore what they do charge is acceptable.                 
  MS. HOOD said she thought the Juneau Department of Health                    
  and Social Services bills insurance companies at a higher                    
  amount for their clinicians than what private practice                       
  therapists charge.                                                           
  Number 160                                                                   
  REP. MULDER asked Ms. Hood if her practice was covered by                    
  state employee coverage.                                                     
  MS. HOOD said she could see clients who were state                           
  employees, but she had to do this in a roundabout way.  She                  
  explained that a physician's referral and supervisory                        
  statement was needed because of the physician's license.                     
  She said physicians were very supportive of counseling                       
  because it often helped with medical symptoms, such as                       
  chronic headaches and stomach aches, which frequently have                   
  psychosomatic aspects.  She added that she thought it a                      
  legitimate consideration to be working under her own license                 
  rather than a physician's.                                                   
  Number 174                                                                   
  REP. MULDER asked if the administration viewed this as a                     
  cost saving mechanism for health care.                                       
  CHAIRMAN HUDSON indicated a zero fiscal note and stated that                 
  HB 545 simply adds marital and family therapists to the line                 
  for insurance so that they might receive treatment similar                   
  to that of other professionals.  He said they had not                        
  received any negative remarks from the administration.                       
  Number 180                                                                   
  REP. MACKIE moved to pass CSHB 545(L&C) from committee with                  
  individual recommendations and zero fiscal note.                             
  Number 184                                                                   
  CHAIRMAN HUDSON, hearing no objection, declared it was so                    
  CHAIRMAN HUDSON then announced HB 458 was the next order of                  

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